Background: Community-based antiretroviral therapy initiation (CB-ARTi) has the potential to reduce attrition by increasing access to care, reducing patient costs, decongesting clinics and ensuring improved uptake of ART. There is a paucity of research that identifies successful implementation of CB-ARTi in sub-Saharan Africa (SSA).Objectives: The aim of the study was to review and describe the evidence on the effectiveness of CB-ARTi programmes that start ART in communities in comparison with the current standards of care in SSA.Methods: A rapid review of grey and published peer-reviewed literature between January 2009 and July 2019, by using PubMed, PDQ-Evidence, Google Scholar, clinical trial databases and major HIV (human immunodeficiency virus) conference websites, was conducted. Search terms used included ‘community-based’, ‘home initiation community models’, ‘antiretroviral therapy’, ‘clinical outcomes’, ‘viral suppression’, ‘retention in care’, ‘loss to follow-up’, ‘HIV’ and ‘sub-Saharan Africa’.Results: The search yielded 90 articles and reports following the removal of duplicates. After initial screening and full-text screening, six articles remained and were included in the qualitative narrative synthesis. This included four randomised control trials and two cohort studies of specific interventions comparing CB-ARTi with the standard of care in SSA. There is evidence that CB-ARTi can increase access to HIV-testing services, linkage to ART, retention in care and viral suppression rates and is possibly not inferior to facility-based healthcare.Conclusion: CB-ARTi has the potential to increase access to HIV services to people living with HIV in SSA. The results mentioned previously suggest that CB-ARTi models could prove to be equal and possibly not inferior to facility-based ones and warrant further investigation.

Background: Continuous quality improvement (CQI) is essential for HIV and tuberculosis (TB) services. Similarly, a thorough understanding of the requirements and impact of CQI is critical to its successful institutionalisation. However, this is currently lacking.Objectives: The objective of this study is to describe the CQI implementation process and examine its effect on HIV and TB service delivery at selected primary healthcare facilities in two South African districts.Method: We used a separate sample, pre- and post-test, quasi-experimental study design based on data collected from the clinical audit of patient cohorts seen in 2014 and 2015 respectively. Quality was measured based on the extent to which prescribed services were provided. Tailored CQI interventions were implemented based on service delivery gaps identified by the 2014 CQI audit. Data were summarised and analysed using a combination of univariate and multivariate analysis.Results: The services identified as low quality were related to opportunistic infections management and laboratory practices. Compliance to prescribed service items in antiretroviral treatment initiation and monitoring, pharmacy and laboratory management, exceeded 70% across study sites. Over 80% of low quality service delivery items were optimised in less than six months with targeted quality improvement support.Conclusion: The observed improvements signal the effectiveness of the CQI approach, its capacity to rapidly improve under-performance, its high replicability and the need to provide quality maintenance support to sustain or improve healthcare facilities performing well. The study strongly underscores the need to improve the management of opportunistic infections and complications, particularly TB.

Background: Men who have sex with men (MSM) and transgender (TG) people face human rights violations (HRVs) which impact their access to critical interventions for HIV prevention, treatment, and related services.Objectives: This study describes how Beyond Zero, a not-for-profit organisation in South Africa built an HRV reporting system and discusses data on the HRVs experienced by MSM and TG people who accessed HIV prevention services between 01 January 2021 and 31 December 2021.Method: This was a cross-sectional study using secondary analysis of programmatic data routinely collected as part of HIV prevention programmes for MSM and TG in 10 rural districts of South Africa.Results: A total of 249 individuals reported having experienced HRVs. Of these, 113 (54.6%) were physical violations, 145 (58.2%) were psychosocial harassment, 15 (18.3%) were experienced within the workplace, and 59 (23.7%) were experienced at a healthcare or social services institution. Overall, 77% of the physical violations and 70.4% of the psychosocial violations occurred in the home and local community settings; 76.1% of the perpetrators of physical violence and 79.3% of the perpetrators of psychosocial harassment were known. Most incidents of physical violence (80.5%) and psychosocial harassment (92.4%) were not reported due to fear of homophobic or transphobic violence.Conclusion: Our findings demonstrate the feasibility of documenting HRVs among MSM and TG people within HIV prevention programmes. Men who have sex with men and TG people should be systematically screened for HRVs and linked to legal or other services.Contribution: Our findings present data on the nature of HRVs in 10 districts outside of the large urban centres where research documenting the lived experiences of MSM, TG people and other key populations is traditionally conducted in South Africa. Such data contribute to addressing the gap in the literature on the needs of MSM and TG people in South Africa caused by the delayed inclusion of rural MSM and TG people in research.

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